Abstract Naso-orbito-ethmoid (NOE) fractures in paediatric patients are uncommon but can result in significant functional and aesthetic impairments if not managed promptly. This case report describes a paediatric patient, who sustained an NOE fracture following self-fall. The patient exhibited pain, periorbital swelling, ecchymosis, and depressed nasal bridge. The patient was evaluated clinically and radiologically, revealing displacement of the NOE complex. Given the potential for long-term complications, open reduction and internal fixation with a stainless steel plate and screws under general anaesthesia was performed to restore the structural integrity and aesthetics of the midface. The patient’s postoperative recovery was uneventful, with no functional or cosmetic deficits noted during the follow-up. This case emphasises the efficacy of stainless steel fixation in paediatric NOE fractures. The gullwing incision offered excellent access, and a single 1.5-mm stainless steel plate with two screws was sufficient for stabilisation. Plate removal at 8 weeks helped minimise growth interference. The 6-month follow-up confirmed functional and aesthetic success.
Abstract Background: Globally, the burden of peripheral vascular disease and other diseases in the remit of the vascular surgeon has been on the rise. Health systems globally have responded to the rise in the burden of peripheral vascular disease, particularly in their regions, by investing in training, research, and other initiatives to improve access and the quality of care. Unfortunately, regions in the Global South, especially West Africa, have significantly lagged behind. Methods: This narrative review synthesised existing evidence on the current state of vascular surgical training and clinical practice in West Africa using a search strategy across databases, including PubMed, MEDLINE, Google Scholar, African Journal Online, and other credible institutions like the World Health Organisation. Discussion: Our article highlights a significant unmet need across West Africa for access to care for patients with vascular diseases. It also found a significant lag in the training of vascular surgeons and the requirement for modern technology to provide the necessary level of modern vascular care. Furthermore, investment in this area across West Africa has been low. Conclusion: In the West African sub-region, vascular surgery is a specialty with inadequate manpower, while the incidence of vascular disease is increasing in the region. There is a need to improve vascular care through increased training centres and opportunities, incentivised training, local, regional, and global collaboration, in addition to improving local and global funding and investment in the specialty across West Africa.
Abstract Introduction: Treatment of cyanotic congenital heart disease (CHD) is essentially surgical. However, in the low-income countries, cardiac surgery remains inaccessible to most of the patients due to financial or technical reasons. Then, surgical management has to be readjusted. In this work, the authors report their experience in surgery for cyanotic CHD in Burkina Faso. Materials and Methods: This was an analytical cross-sectional study conducted over a period of 38 months. It included patients who underwent surgery for cyanotic CHD at the University Hospital of Tengandogo with a minimum follow-up of 3 months. Results: A total of 41 patients were enrolled. The median age was 7 years, with a male predominance (sex ratio = 2.15). Tetralogy of Fallot was the most frequently observed echocardiographic anomaly, with its regular form being the primary surgical indication (68.3%). A total of 31 complete repairs and 10 palliative surgeries were performed using standard recommended techniques. The complication rate was 48.9%, and the 3-month survival rate was 90.24%. Mortality rate was 9.8% in the group “complete repair” and nil in the group “palliative surgery.” Haematocrit levels above 55%, haemoglobin levels above 16 g/dL, and the presence of heart block were associated with the occurrence of short-term postoperative complications. Conclusion: Surgery for cyanotic CHD has significantly improved the life expectancy of affected patients in Burkina Faso. Palliative surgery is still a good option for treating symptomatic patients when there is a limited technical set. Controlling the morbidity and mortality factors is crucial for achieving better postoperative outcomes.
Abstract The Morel-Lavallée lesion (MLL) is a closed degloving injury that is the result of a shearing mechanism of trauma. Here we present a case of paediatric MLL in a 15-month-old child, which was diagnosed and managed at a hospital in rural Gabon. She presented after a motor vehicle vs. pedestrian accident with a tender, fluctuant mass of the back and buttocks. Ultrasonography revealed a large but discrete fluid collection between the subcutaneous fat and the deep fascial planes, extending from the paraspinal soft tissues to the right gluteal region. A diagnosis of MLL was made. This patient was managed with ultrasound-guided percutaneous drainage and compression bandages before eventually requiring debridement of a region of nonviable skin. These types of lesions are exceedingly rare in children less than 10 years of age, which is likely a result of different biomechanical factors and mechanisms of injury in this population.
Abstract Background: Neurocritical care is indispensable for the optimal management of neurosurgical patients; however, its status in sub-Saharan Africa remains nascent. Relevant epidemiological data are essential for enhancing the treatment outcomes of paediatric neurosurgical patients; however, no public data exist on their critical care requirements. Materials and Methods: This is a retrospective study of the clinical records of all paediatric neurosurgical patients admitted into our facility’s paediatric intensive care unit (PICU) from March 2022 to July 2024. Results: We managed 32 neurosurgical patients in our hospital’s PICU during the study period. These had a male-to-female ratio of 1.9:1. The patients ranged in age from three months to 16 years, with a mean age of 3.4 years. Most referrals came from public healthcare facilities, accounting for 56.3% (18/32) of cases. The predominant indication for PICU admission was post-operative care (22/32; 68.75%), 14 (63.6%) of which were brain tumour-related. Eight (25.0%) of these patients were managed for traumatic brain injury (TBI). The Glasgow Coma score at presentation was ≤ 8 in 17 (53.1%) of the patients, while 24/32 (75%) of the patients required ventilatory support. The combined monthly income of 40.6% (13 parents) exceeded 200,000 Naira. Nineteen (59.4%) cases spent ≤ 7 days in PICU, and the 30-day survival rate was 75%. Conclusion: The main indications for PICU admission in our series were TBI and post-operative care for brain tumours, with favourable treatment outcomes observed in most of the patients. These findings underscore the need for standardised management protocols for TBI and post-operative neuro-oncological care in paediatric neurocritical care in Nigeria.
Abstract Background: Airway management in maxillofacial surgery can be challenging due to anatomical and pathological obstructions. Aims and Objective: To evaluate the indications of tracheostomy, duration of the surgical procedure, duration of tracheostomy cannulation, and the complications associated with tracheostomy in oral and maxillofacial surgical outreach programmes. Design of the Study: A retrospective study. Setting: Cleft and Facial Deformity Foundation/International Craniofacial Academy, Abuja. Material and Methods: Data collected included demographics, indications for tracheostomy, type of incision, procedural timing of the procedure, duration of cannulation, and postoperative complications. Ethical clearance was obtained, and data analysis was performed using Statistical Package for the Social Sciences version 20, with results presented as descriptive statistics. Statistical significance was set at P > 0.05. Results: The study included 27 patients (59.3% male, 40.7% female), with a mean age of 24.6 years. Primary indications for tracheostomy were temporomandibular joint ankylosis (48.1%), large orofacial tumors (40.7%), and ankylosis due to Noma (11.1%). Tracheostomies were performed electively in 81.5% of cases, while 18.5% were emergency procedures. The average time to complete each tracheostomy was approximately 27.5 min. Cannulation lasted between 24 and 48 h, with an average of 26.7 h. Complications were recorded in 2 (7.4%) cases. Conclusion: Tracheostomy was performed by oral and maxillofacial surgeons, with an average operation time of approximately 27.5 min. The procedure could be elective or emergency, and cannulation was maintained for a short duration of 27 h. Tracheostomy is a safe, adaptable, and essential technique for airway management in maxillofacial surgeries.
Abstract Background: Neoadjuvant chemotherapy (NACT) is an integral component of the management of locally advanced breast cancer. Preliminary studies on response assessment within the Ghanaian population have been conducted using clinical methods. The rate of pathological responses in patients with locally advanced breast cancer treated via NACT is yet to be studied in the Ghanaian patient population, as well as in the immunohistochemistry-based phenotypic subtypes. Materials and Methods: A retrospective-prospective cohort study at a single tertiary centre was undertaken between January 2018 and March 2019. A total of 56 patients with locally advanced breast cancers (stage III only) were managed by a multidisciplinary team at Komfo Anokye Teaching Hospital, Kumasi with chemotherapy, surgery and hormone therapy. Clinicopathologic staging was performed prior to the initiation of NACT, followed by mastectomy and axillary lymph node dissection. To evaluate the pathological response to chemotherapy, post-mastectomy specimens were compared with corresponding pre-treatment core biopsy samples. The assessment of response patterns was conducted using the Miller and Payne grading system, which quantifies changes in tumour cellularity within the breast tissue. Results: Grade 2 of the Miller–Payne criteria was the dominant pathological response in 18/56 (32.1%) of the specimens. Pathological complete response (pCR) occurred in 13/56 (23.2%) cases. Phenotypic subtyping was conducted for 31 out of 56 participants with available immunohistochemical data. Among these, the triple-negative breast cancer subtype demonstrated a pCR in 6/31 cases (19.4%), representing the highest response rate compared to other molecular subtypes. Conclusion: In this single-centre cohort, we describe the distribution of Miller–Payne grades and the rate of breast pCR after NACT. These findings provide preliminary, local response data and highlight the need for larger studies with standardised breast-and-nodal pCR endpoints and survival follow-up.
Abstract Introduction: Parents are the key decision makers in the eye care of their children. This study aimed to assess the knowledge, attitude, and practices (KAPs) towards childhood eye diseases among parents in a rural community in southeastern Nigeria and to determine the factors affecting the KAP. Materials and Methods: A descriptive cross-sectional population-based survey was conducted among parents in Obuoffia Community, Nkanu West local government area of Enugu state, Nigeria. Data were collected using a pretested interviewer-administered questionnaire. Data were analysed with IBM Statistical Package for the Social Sciences. Descriptive, chi-square, and logistic regression statistics were done, and a P value of <0.05 was considered statistically significant. Results: There were 597 participants. The proportion of participants with good knowledge was 76.2%, those with positive attitudes was 75.2%, and those with good practice was 22.4%. Good knowledge was significantly associated with being married, on salaried employment, having at least secondary education, and having a positive attitude. Positive attitude was associated with being employed and good knowledge ( P < 0.05). Good eye care practice was significantly associated with older age ≥45 years, being employed, and having a positive attitude. The significant predictors of good practice were age ≥45 years and a positive attitude. Belief in the use of traditional eye medications for red or discharging eyes was common. Conclusions: There was overall good knowledge and positive attitude towards childhood eye diseases among parents in Obuoffia, but these did not translate to good practice. Intervention eye care programmes integrated with primary healthcare and targeted at parents less than 45 years of age are recommended.
Abstract Background: Closure of the peritoneal flap during laparoscopic transabdominal preperitoneal (TAPP) repair is a critical step. Barbed sutures have been proposed to simplify this process, but comparative data with non-barbed sutures are limited. We conducted this study to compare absorbable barbed sutures (polyglyconate) with absorbable non-barbed sutures (polyglactin 910) for peritoneal flap closure in TAPP repair of primary inguinal hernias, focusing on closure time, operative time, postoperative pain, and complications. Materials and Methods: This randomised comparative study was conducted at ABVIMS and Dr. RML Hospital, New Delhi, including 60 adult patients with primary unilateral inguinal hernia undergoing TAPP repair. Patients were divided into two groups: Group A (barbed sutures, n = 30) and Group B (non-barbed sutures, n = 30). Primary outcomes included peritoneal closure time and total operative time. Secondary outcomes were postoperative pain (visual analogue scale), ease of surgery, and incidence of seroma or haematoma. Statistical analysis was performed using Statistical Package for the Social Sciences v23, with P < 0.05 considered significant. Results: Barbed sutures significantly reduced peritoneal closure time (8.61 ± 0.78 min vs. 13.40 ± 0.81 min, P < 0.001) and total operative time (102.5 ± 16.65 min vs. 110.53 ± 11.09 min, P = 0.013). However, postoperative pain was higher in the barbed suture group at 48 h ( P = 0.005) and 7 days ( P = 0.043). There was no significant difference in seroma or haematoma formation between the groups ( P = 0.472). Conclusion: Absorbable barbed sutures are effective in reducing closure and operative times in TAPP hernia repair but may be associated with higher early postoperative pain. They offer a useful option for improving operative efficiency without increasing complication rates.
Abstract Introduction: Restoring aesthetics in primary teeth presents a significant challenge for dentists due to factors such as thin enamel, unique pulpal anatomy, and the small size of these teeth. Discolouration, malformation, extensive caries, or damage from trauma in primary teeth often raise considerable concerns for both patients and their parents. Composite resin has become one of the most popular and reliable tooth-colour restorative materials, offering excellent aesthetic outcomes. Aim: To evaluate the cost effectiveness, retention, and secondary caries of universal adhesive Tetric N-Bond Vivapen and conventional adhesives followed by the composite restorations. Materials and Methods: Two dental adhesive products was used: conventional adhesive and Tetric N-Bond universal Vivapen. The study included 30 children who required composite restoration and were divided into two groups. Group 1 was treated with conventional adhesive and Group 2 with Tetric N-bond. After treatment, the cost-effectiveness was assessed immediately, and children were followed-up after 12 months for the evaluation of retention and secondary caries. Results: The study showed that Tetric N-Bond Universal Vivapen is more cost-effective than conventional adhesive. Group 2 experienced significantly better outcomes for both retention of restoration (100% vs. 53.8%, P = 0.003) and incidence of secondary caries (100% vs. 15.4%, P < 0.001) over a 1-year period compared to Group 1. Conclusion: The study concludes that Tetric N-Bond Universal Vivapen is cost-effective, provides better retention, and reduces secondary caries compared to conventional adhesives, making it more durable for composite restorations in dental treatment.
Abstract Background: Typhoid fever is a severe infectious disease prevalent in developing countries. This enteric fever can cause ulceration with perforation, typically in the terminal ileum. There is insufficient evidence regarding the prevalence and morbidity of perforated typhoid in endemic areas such as Togo, West Africa. Our aim was to evaluate and improve mortality rates in patients with typhoid perforation at Hospital of Hope (HOH). Materials and Methods: A retrospective review of 180 patients with perforated typhoid at HOH in Togo, West Africa, examined surgical outcomes from January 1, 2020, to January 7, 2024. We assessed the effectiveness of a new institutional treatment protocol implemented in February 2023. The change was driven by a higher-than-expected mortality rate. Additionally, demographic, treatment, clinical, and surgical characteristics were abstracted. Results: From January 2020 to July 2024, the mortality rate was 20.00% ( n = 36); 69.44% of patients who died suffered from septic shock ( n = 25). To mitigate septic shock, HOH’s protocol change lowered the threshold for damage control surgery including performing an ileostomy. This change was associated with 44% lower odds of death (15.45% vs. 25.14%, P = 0.056). The mortality rate of patients undergoing surgery with only one perforation (13.51%, n = 15/111) was lower compared to those with moderate (6.52% n = 3/46) or severe contamination (40.74%, n = 22/54) and/or multiple perforations (26.58%, n = 21/79). Of surviving patients ( n = 55) with an ostomy, 85.45% ( n = 47) underwent stoma reversal. Discussion: This demonstrates that ileostomies can be a safe and effective management therapy of typhoid perforations in settings of late presentation, malnutrition, and low resources.
Abstract Background: Surgical site infection is a major cause of post-operative morbidity and mortality, and pre-operative skin preparation is a measure taken to reduce it. The agents used for skin preparation are either chlorhexidine-based or iodine-based, with no consensus on the ideal pre-operative skin preparation method. Objective: To compare the surgical site infection rate for clean-contaminated laparotomy operations when pre-operative skin preparation was done with 10% povidone-iodine or with a combination of chlorhexidine, cetrimide (Savlon), and methylated spirit at Jos University Teaching Hospital. Materials and Methods: This was a retrospective study, and patients’ information was accessed from their medical records. Data was analysed using Statistical Package for Social Sciences version 22 statistical software. Comparison of qualitative variables was analysed using Fisher’s exact test and quantitative variables with Student’s t test. The level of significance was at 0.05, and the confidence interval of 95% when the surgical site infection (SSI) rates were compared. Results: Seventy-five patients were enrolled into the study, 36 (48%) were in the povidone-iodine group, while 39 (52%) were in the chlorhexidine group. In all, three (8.3%) patients from the povidone-iodine group developed SSI, while for the chlorhexidine group, it was 3 (7.7%). There was no statistically significant difference in the SSI rate between the two groups ( P = 0.919). Conclusion: There was no significant difference in the SSI rate between the povidone-iodine and chlorhexidine method of skin preparation. Hence, either of the two methods could be used for clean-contaminated laparotomies.
Abstract Introduction: Varicocele is surgically managed by an open or laparoscopic approach. The complications of the laparoscopic approach, such as artery ligation, lymphatic ligation, postoperative hydrocele, and recurrence, can be reduced with adequate visualisation and identification of the spermatic vein with the help of indocyanine green (ICG). Materials and Methods: A randomised controlled trial was conducted on 20 patients presenting with symptomatic varicocele. They were divided into two groups – group I (patients not given intraoperative ICG) and group II (patients given intraoperative ICG). After giving a test dose of ICG, patients were taken up for laparoscopic varicocele ligation. The perioperative findings were noted and compared between the two groups. Results: Data were analysed with significance considered with a P value < 0.05. Eighty percent of the patients were between 21 and 40 years of age. The mean operative time was significantly less in group II (77.2 ± 28.54 vs. 55.1 ± 28.78 min) ( P < 0.001). Postoperatively, there was a significant difference in sperm count ( P = 0.04) and motility ( P < 0.01) in group I, whereas in group II, there was a significant difference in sperm concentration ( P = 0.03) and motility ( P < 0.001). Conclusion: Intraoperative administration of ICG leads to a significant decrease in operative time due to the early identification of the spermatic vessels and early ligation of the spermatic vein. Postoperative complications such as hydrocele and recurrence of varicoceles are reduced when ICG is used in these cases, with a significant improvement in post-surgical sperm motility and concentration.
Abstract Introduction: The volume of the testis, mainly made up of seminiferous tubules, is a reflection of spermatogenesis. The accurate measurement of the testicular volume is therefore critical in the evaluation of testicular function. Aim is to compare the volumes obtained by Prader orchidometer, calliper and ultrasound with actual volume in humans. Materials and Methods: One hundred testicles from 50 men with advanced prostate cancer were recruited into the study over a 12-month period. Testicular volume was estimated in vivo using Prader orchidometer, calliper, ultrasound scan and in vitro after orchidectomy by water displacement. Statistical Analysis Used: Statistical analysis used paired t test, Pearson correlation coefficient and simple linear regression analysis. Results: The age of the patients ranged from 55 to 82 years (mean 71.66 ± 6.5). The mean testicular volumes were 16.13 ± 4.5, 9.07 ± 3.5 and 13.48 ± 4.3mL for Prader orchidometer, calliper and ultrasound (Lambert formula), respectively. The mean volume from water displacement was 15.08 ± 4.3 mL. The Prader orchidometer most appropriately estimates the actual volume, ( P = 0.657). Calliper significantly underestimated the actual volume. Ultrasound estimation by Lambert formula showed no significant mean difference from the actual volume ( P = 0.362). In addition, the orchidometer and Lambert ultrasound formula showed excellent positive correlation with the actual volume ( r = 0.931, P < 0.001) and ( r = 0.869, P < 0.001), respectively. Conclusions: Prader orchidometer provides an accurate and rapid assessment of testicular volume; it is, therefore, useful in clinical practice. Calliper does not give an accurate assessment of testicular volume. Of the three ultrasound formulae, Lambert formula is the best in providing a near accurate testicular volume measurement.
Abstract Background: Posterior scalp defects are trivial defects to reconstruct due to the location, defect size, exposed calvaria/implants, and lack of local tissue. They are also pressure-bearing areas. These require optimal reconstruction for adequate postoperative functional outcomes with less complications. Materials and Methods: Here, we collected data of our operated patients (four patients) involving posterior scalp and neck defects of varying etiologies like acne keloidalis nuchae, dermatofibrosarcoma, postoperative implant exposure, and trichilemmal carcinoma, all of which were managed using a pedicled lower trapezius myocutaneous flap. The details of the patient, procedure, and outcome were tabularised in the results section. Results: All patients underwent optimal coverage of defects with trapezius myocutaneous flap reconstruction. Three patients had uneventful recoveries, and one developed wound infection and dehiscence, which was effectively managed with negative pressure wound therapy and secondary suturing. No major flap-related complications or functional deficits in the trapezius muscle were noted. Patients remained asymptomatic and satisfied during follow-up periods of up to 2 years. Conclusion: Despite advancement of microsurgical techniques and ease of performing microsurgery, the lower trapezius myocutaneous flap has its merits as a suitable alternative to free tissue transfer for coverage of posterior scalp and neck defects.
Abstract Background: Necrotising fasciitis (NF) is a life-threatening soft tissue infection requiring early diagnosis and aggressive surgical intervention. The Laboratory Risk Indicator for NF (LRINEC) score was introduced to aid early diagnosis using common laboratory parameters. However, its performance in Indian settings requires validation. Objectives: The objective of this study was to evaluate the correlation between LRINEC scoring and histopathological examination (HPE) findings and assess the clinical utility of LRINEC in diagnosing NF. Materials and Methods: A prospective observational study was conducted on 90 patients with suspected NF at a tertiary care hospital. LRINEC scores were calculated using C-reactive protein (CRP), white blood cell, haemoglobin, serum sodium, creatinine, and glucose. Scores were stratified and correlated with intraoperative histopathological findings. Receiver operating characteristic (ROC) curve analysis was used to assess diagnostic accuracy. Results: Among 90 patients, 88.8% were male (mean age: 52.2 years). High LRINEC scores significantly correlated with positive HPE ( P < 0.01). ROC analysis revealed an area under the curve of 0.635 for the LRINEC score predicting NF. CRP and serum sodium were the most predictive components. Mortality increased with higher LRINEC categories. Conclusion: LRINEC score demonstrates a strong correlation with histopathological evidence of NF and serves as a reliable adjunct in early diagnosis in the Indian clinical setting. However, it should be used in conjunction with clinical judgement and not as a stand-alone diagnostic tool.
Abstract Background: The concept of day-case surgery was initially very slow in gaining acceptance among surgeons in Nigeria and other developing countries due to widespread scepticism and unfounded apprehension. However, there is increasing adoption of day-case surgery in many developing countries due to challenges with access to the operating theatre and the risks associated with prolonged immobilisation following surgery. The study aimed to profile the indications for day-case surgery on the plastic and reconstructive surgery service at the University College Hospital Ibadan over a 4-year period (2020–2023), identify complications, and determine the readmission rate from such procedures. Materials and Methods: A 4-year retrospective review of day-case surgeries performed on the plastic and reconstructive service of the University College Hospital, Ibadan, between January 2020 and December 2023 was done. The information obtained included the demographic characteristics of the patients, the diagnosis, type of anaesthesia, postoperative analgesic used, complications, and readmission rate following discharge of the patients. The data obtained were analysed using IBM SPSS version 22. Results: A total of 156 day-case plastic surgery procedures were done; this accounted for 24.8% of all the elective plastic surgery procedures done over the year under review. Only 103 case files were able to be retrieved (retrieval rate of 66%). The mean age was 33 years (SD 14.7 years). There were 56 males and 47 females, with a male-to-female ratio of 1.2:1. All patients reside within the Ibadan metropolis. Most of the patients were American Society of Anaesthesiologists (ASA I; 95.1%), while 4.9% were ASA II. The most commonly performed surgery was keloid excision 24 (23.3%), followed by lipectomy 15 (14.6%), ganglionectomy 10 (9.7%), in-growing toe nail procedure 8 (7.8%), pyogenic granuloma excision 7 (6.8%), slit-ear lobe repair 6 (5.8%), epidermoid cyst excision 5 (4.9%), sebaceous cyst excision 4 (3.9%), giant cell tumour excision 3 (2.9%), and others. Local anaesthesia was used in 98.6% of patients. Postoperative complications occurred in seven (6.8%) of patients, with surgical site infection being the most common complication (3.9%). No patient had admission conversion or readmission. No mortality was recorded. Conclusion: Day-case plastic surgery operation is safe with minimal complications in carefully selected patients. The scope of the procedures can further be increased in order to increase the patient’s access to surgery.
Abstract Background: Trans-rectal ultrasound (TRUS) Doppler assessment of the prostate can complement TRUS-guided biopsy of the prostate in the diagnosis of prostate cancer. Aim: This study aimed to correlate the trans-rectal Doppler sonography findings and tumour grade in Nigerian men with prostate carcinoma. Materials and Methods: This was a prospective longitudinal study of men counselled for prostate biopsy after a written informed consent was obtained. Patients who met the inclusion criteria had six (sextant) core biopsy samples taken from the peripheral zone of the prostate. In addition, targeted biopsies from areas of increased vascularity on colour Doppler ultrasound outside the six core areas were also included in the study. Pathological results were correlated with the imaging data. Results: Sixty-nine patients met the inclusion criteria for the study. The mean age was 70.22 ± 8.91 years. The median Gleason grade was 8.0, indicative of a high-grade tumour among the patients. All 69 patients had prostatic adenocarcinoma on histological examination. Overall, 69.6% had high-grade tumours on TRUS Doppler sonography-guided biopsy, indicating a high percentage of high-grade tumours. There was a statistically significant correlation between the Doppler ultrasoundfindings and Gleason score ( r = 0.837; P < 0.0001). Conclusion: Addition of colour Doppler scan to routine TRUS examination can help map out areas for targeted biopsies during prostate biopsies. Areas of increased vascularity correlated with high Gleason’s grade and tumour grade.
Abstract Background: Addition of fentanyl to 0.5% hyperbaric bupivacaine for subarachnoid block (SAB) enhances the efficacy of bupivacaine and enables the use of reduced doses of the two drugs, thereby minimising their adverse effects. However, fentanyl may cross the placenta and cause chest wall rigidity, cardiovascular and respiratory depression in the foetus, resulting in poor neonatal outcome. Objectives: This study aimed to determine and compare the effects of 20 and 25 µg fentanyl added to 10 mg 0.5% hyperbaric bupivacaine on the outcome of neonates delivered by caesarean section under SAB. Materials and Methods: Ninety-nine pregnant women, aged 18–45 years and American Society of Anaesthesiologists I and II, were randomly divided into three equal groups: group A, group B, and group C. Each group received 2 mL (10 mg) 0.5% hyperbaric bupivacaine, and in addition, group A received 0.5 mL normal saline, group B received 0.4 mL (20 µg) fentanyl + 0.1 mL normal saline, whereas group C received 0.5 mL (25 µg) fentanyl. Following delivery, the newborn babies’ Apgar scores, Neurological and Adaptive Capacity Scores (NACS), umbilical cord arterial blood gas, peripheral oxygen saturation (SpO 2 ), and pulse rate were assessed. Results: The mean Apgar scores at 1 and 5 min and the mean NACS at 15 min and 2 h were significantly lower in the fentanyl/bupivacaine groups compared with the bupivacaine only group ( P < 0.001). The mean pH and SpO 2 /PR of the neonates were within normal neonatal range but decreased from group A to group C ( P < 0.05). Conclusions: Neonates whose mothers received bupivacaine only had better outcomes than those who received bupivacaine/fentanyl combination, whereas those who received 20 µg fentanyl had better outcomes than those who received 25 µg.
Abstract Background: Nigeria has a large population under the age of 18 years who require access to paediatric plastic surgery care. We aimed to assess the structure and scope of paediatric plastic surgery practice in Nigeria. Materials and Methods: Questionnaires were distributed to plastic surgery residents and consultants who were attending the 17th Nigerian Burn Injury Society and 29th Nigerian Association of Plastic, Reconstructive, and Aesthetic Surgery annual scientific conference in September 2024. Results: The four most common conditions in the paediatric population encountered by the respondents were burns and their complications (97.8%), congenital hand differences (97.8%), trauma from other causes (97.8%), and craniofacial cleft (84.8%). None of the respondents had a theatre dedicated solely to paediatric cases, and 93.5% did not have a paediatric plastic surgery clinic. Inadequate workforce (84.4%) and administrative bottlenecks (68.9%) were identified as the two most common obstacles to providing a dedicated paediatric plastic surgery service. About 67% of respondents said they required further training in paediatric plastic surgery. Conclusion: Burns and their complications, congenital hand differences, trauma, and craniofacial clefts are common reasons why a paediatric patient will present to a plastic surgeon in Nigeria. There are no dedicated paediatric plastic surgery clinics and theatres in most places. Inadequate workforce and administrative bottlenecks are the two top reasons preventing dedicated paediatric plastic surgery care. There is a need for further training in paediatric plastic surgery care among residents and consultants.
